Provider Demographics
NPI:1275214629
Name:BETHANY ISON LICSW, LLC
Entity Type:Organization
Organization Name:BETHANY ISON LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-343-3332
Mailing Address - Street 1:31 HOME DEPOT DR # 236
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2669
Mailing Address - Country:US
Mailing Address - Phone:774-343-3332
Mailing Address - Fax:
Practice Address - Street 1:19 E WIND DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2714
Practice Address - Country:US
Practice Address - Phone:774-343-3332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty